Not Further Specified: Unclassified Orthopedic Injuries in Trauma Registries, Cause for Concern?

Area of Science:

• Orthopedic Surgery
• Trauma Registries
• Data Quality

Background:

• Data accuracy is crucial for reliable outcomes research, particularly in orthopedic surgery.
• Nonspecific data entries can compromise study results and risk adjustment capabilities.
• This study addresses the under-examined issue of data quality in orthopedic trauma research.

Purpose of the Study:

• To evaluate the prevalence of Not Further Specified (NFS) orthopedic injury codes.
• To assess data quality in two major trauma registries: the National Trauma Data Bank (NTDB) and the Michigan Trauma Quality Improvement Program (MTQIP).

Main Methods:

• Utilized data from NTDB (2011-2015) and MTQIP (2011-2017).
• Selected orthopedic injuries classified using the Abbreviated Injury Scale, version 2005 (AIS2005).
• Calculated the percentage of NFS entries for specific injuries within each registry.

Main Results:

• A substantial proportion of fractures were classified as NFS: 18.5% in MTQIP and 27% in NTDB.
• NFS entries were significantly higher for complex fractures (34.5% MTQIP, 41.8% NTDB) compared to simple fractures (9.6% MTQIP, 15.7% NTDB).
• The proportion of NFS codes varied based on trauma center level and differed between registries.

Conclusions:

• The high percentage of nonspecific entries in these trauma registries is a significant concern.
• These data quality issues can negatively affect research findings and the ability to perform accurate risk adjustment.
• Further research is recommended to identify the underlying causes of these nonspecific coding practices.